884

has already become general. Asimilar result would inevitablyfollow the coininetiectuout of a well-advised scheme for the

training of nurdes ill a4ylanis. Until such a system is

established, it is of the greatest imhurtance to pay goodwages to attendants, and to see that they are otherwise madeas comfortable a3 possible. It is only iu this way that agood class of persons can ba attracted to the service, andwhat is of even greater importance, induced to remain in it.

Public Lealth and Poor Law.LOCAL GOVERNMENT DEPARTMENT.

REPORTS OF MEDICAL OFFICERS OF HEALTH.

Guisboro’ Dastract.-Dr. W. W. Stainthorpe issues separatereports to the several sanitary authorities in the Guisboro’Union. In both the urban and rural portions of the districthe calls attention to the frequency with which the ordinarymidden-privy serves as a means for conveying the spread ofenteric fever, and he urges the adoption of movable

receptacles beneath the privy seats. Under such a systemthe infection of such a disease as enteric fever is localised,the contents of each receptacle can be disinfected, a freshreceptacle can replace the one needing disinfection, consider-able facilities are experienced in the process of scavenging,and, above all, an end is put to that system which has led toso much preventable disease-namely, the system of storingup large quantities of excrement and refuse in close proximityto dwellings. The improved system needs, however, regulararrangements by the sanitary authority itself for systematicand frequent scavenging. Some progress is being made inthe several portions of the district as to this matter of excre-ment and refuse disposal, but it is slow considering thenumber of years since the shortcomings of the presentsystem were pointed out, and especially in view of the factthat in some parts of the district proprietors have, by theirown action, afforded abundant proof to the authorities of thegreat advantages which have followed on the adoption of adifferent system from that of the common midden-privy.

Hartismere Rural Distact.-The death-ratefor this district,which has a population of some 13,500, was as high as 18’4per 1000 last year. Scarlatina was widely prevalent in amild form, and ten separate outbreaks of diphtheria occurred,three of these being at Mellis. The first two were compara.tively isolated and were very limited in their distribution ; thethird, however, was on a wide scale, and was probably theresult ot personal infection under local conditions calculated tofavour the spread of the disease. The result both of this preva-lence and of the scarlet fever outbreak points strongly to theneed of some means for the immediate isolation of first attacksof infectious disease. The death-rate for the parish of Mellishas been worked out by Dr. Edgar Barnes for a long period,and it appears that the average for the past twenty-threeyears reaches as high as 23 ’5 per 1000. The sanitary condi-tion of the place, as described in connexion with the diph-theria outbreak, indicates many easily removable conditionscalculated to injure health, and the extreme dampness of thelarge green around which the houses stand points also to theneed for a system of subsoil drainage. The standard districtsof the Registrar-General only have a death-rate somewhatover 16 ’0 per 1000, and this although some are urban andcontain a larger population than the whole of this ruraldistrict put together. Mellis, on the other hand, only con-tains some 500 souls.Romford Rural District.-Mr. Alfred Wright in his annual

report for this district during 1882, gives a very completetabular account of the measures which he has carried out with aview to prevent the spread of infectious diseases, disinfectionof premises and articles, together with removal to hospitalbeing frequently effected. Reference is made to the sanitarycircumstances of Barking amongst other places. The townis in part drained by imperfect and badly ventilated sewersdischarging into the Creek at low water only, the sewers areso laid with regard to level that many houses cannot draininto them, and the newest portion of the town is a privy andcesspool district. It is said that though more has been donefor this locality during the past two years than had been

effected during the preceding twenty years, yet that the in.habitants have not the grace to acknowledge it. We haveno wish to underrate the value of what has been done, bmit is hardly possible to conceive that the existing anitarvconditions of Barking, a town of some 9500 iuhabitantq,can be too emphatically condemned by the inhabitants, ifthey are correctly described by the medical officer of healthThere may be difficulty in providing the remedy at thepresent stage, but the conditions them-elves are none theless injurious and burdensome. The death-rate oftheentirerural district exhibits a tendency to decline steadily; it nowstands at 17’4 per 1000, and the improvement may fairly heregarded as due in some measure to the active sanitary actionwhich has been taken in the matter of nuisance removal,provisions against infection, &c.

lir7lcathara (Urban).-This small urban district, whichhad, at the time of the last census, a population of only3898 persons, is in close proximity to Redear, a favouriteseaside resort on the Yorkshire coast. The medical officerof health, Mr. W. Walker, in his report for 1882, calculatathe birth-rate in Kirkleatham to have been 31 ’0, and thedeath-rate 14’8 per 1000 of the population. The reportstates that 7 of the deaths were of non-residents (the precisdefinition of " non-resident" is not given), and that bydeducting these deaths, and also one from "prematurebirth" (on what ground this death should be deducted iinot stated), the death-rate may be reduced to 12’8 per 1000.Only 2 deaths resulted from infectious diseases, giving thelow zymotic rate of 0’25 per 1000; and the proportion oiinfant mortality was also satisfactorily low. These factsafford favourable evidence of the sanitary condition of thedistrict. We notice that Mr. Walker, in his report, statesthat the deaths of persons aged one year and under sixtyyears were only at the rate of 6’5 per 1000. This evidently means per 1000 persons at all ages. This rate ivalueless for comparative purposes; rates of mortality aigroups of ages should, to be useful, be calculated upon thinumbers living at the same groups of ages.Lytham (Urban).-The population of this favourite htg(

Lancashire watering-place is estimated by the medical office!of health (Dr. L. Fisher) in his report for 1882 at 423(persons in the middle of that year. The birth-rate last yeaiappears not to have exceeded 27’2 ; whereas Dr. Fisher cal

c ulates the "corrected" death-rate of the district to havebeen so low as 10’1. It should be an invariable practice ithealth reports, when corrections are made, by excludin!the deaths of non-residents, to state precisely the prince iwhich governs the definition of the terms resident and nonresident. Dr. Fisher deducts on this account 15 of the Sdeaths occurring within the district during last year. Itiisatisfactory, however, to know that the death-rate inthedistrict in 1882, without any correction, did not exceed l3’íper 1000. Infant mortality was low, and the death-ratfrom the principal zymotic diseases did not exceed 1 ’9 per 1000:scarlet fever causing 4 deaths. The report also speabfavourably both of the condition of the drainage and of thEquality of the water-supply. All these facts should re-commend themselves to the notice of persons proposing tcvisit this health resort.

VITAL STATISTICS.

HEALTH OF ENGLISH TOWNS.

In twenty-eight of the largest English towns, 5816 birthsand 3745 deaths were registered during the week ending the12th inst. The annual death-rate in these towns, which hadsteadily declined in the six preceding weeks from29’2to21’7 per 1000, rose again to 22’7 last week. During thepast six weeks of the current quarter, the death.rat in itsthese towns averaged 23’5 per 1000, against 21’5 and 22’tin the corresponding periods of 1881 and 1882. The lowestrates in these towns last week were 15’0 in Bradford, 171in Derby, 17’9 in Bristol, and 19’8 both in Portsmouth andSunderland. The rates ranged upwards in the other towns to26’5 in Sheffield, 29’0 in Huddersfield, 30’7 in Liverpool,and 32’9 in Hull. The deaths referred to the principalzymotic diseases in the twenty-eight towns were 386 lastweek, against 344 and 362 in the two previous weeks; theyincluded 99 from measles, 76 from scarlet fever, 97 fromwhooping-cough, 44 from "fever" (principally enteric), 42from diarrhoea, 18 from diphtheria, and 10 from amall.pozNo death was referred to any of these zymotic diseaseseither in Derby or in Wolverhampton; while the highest

885

death-rates from these diseases occurred in Halifax and Hull.Measles was proportionately most fatal in Bristol and

Liverpool; scarlet fever in Halifax and Sheffield; whoop-ing-congh in Plymouth and Hull ; and " fever " inPortsmouth and Birkenhead. The 22 deaths from diph-theria in the twenty-eight towns included 13 in London.Small-pox caused 4 deaths in Newcastle-upon-Tyne,3 in London, 1 in Birmingham, and 1 in Leeds. Thenumber of small-pox patients in the metropolitan asylumhospitals, which.had been 73 and 78 on the two precedingSaturdays, was 77 at the end of last week ; 9 new casesof small-pox were admitted to these hospitals during theweek, against 7 and ’14 in the two previous weeks. Thedeaths referred to diseases of the respiratory organs inLondon, which had declined in the six preceding weeks from672 to 371, rose again to 402 last week, and exceeded thecorrected average by 78. The causes of 94, or 2’8 per cent.,of the deaths in the twenty-eight towns last week werenot certified either by a registered medical practitioner orby a coroner. All the causes of death were duty certified inPortsmouth, Plymouth, Derby, and Birkenhead. The pro-portions of uncertified deaths were largest in Wolverhamp-ton, Oldham, and Hull. -

HEALTH OF SCOTCH TOWNS.

The annual rate of mortality in the eight Scotch towns,which had been equal to 27 ’6 and 25’0 per 1000 in the twopreceding weeks, rose again to 26’1 in the week ending the12th inst. ; this rate exceeded by 3’4 the mean rate lastweek in the twenty-eight English towns. The rates in theScotch towns ranged from 15’3 and 16’3 in Edinburgh andPerth, to 31’1 and 31 ’3 in Glasgow and Greenock. The deathsin the eight towns included 116 which were referred to theprincipal zymotic diseases, showing an increase of 26 uponthe number in the previous week; these deaths were equalto an annual rate of 4 9 per 1000, which was no less than2’6 above the mean rate last week from the same diseasesin the large English towns. The 47 deaths from measlesshowed a further increase upon recent weekly numbers, andincluded 33 in Glasgow, 5 in Leith, and 4 in Edinburgh.The fatal cases of whooping-cough, which had declined from57 to 25 in the eight previous weeks, rose again to 31 lastweek, of which 14 occurred in Glasgow, 5 in Edinburgh, 5in Dundee, and 4 in Leith. The deaths from scarlet feveralso showed an increase, and included 8 in Glasgow, and 2both in Edinburgh and Aberdeen. The deaths attributed todiphtheria, which had been 12 and 4 in the two previousweeks, rose again to 10 last week, of which 7 occurred inGlasgow and 2 in Greenock. The 5 deaths referred to

"fever," including 4 in Glasgow, were again considerablybelow the average. The deaths from acute diseases of thelungs in the eight towns, which had been 119 and 132 in thetwo previous weeks, were 121 last week, and exceeded by 8the number in the corresponding week of last year. Thecauses of 111, or nearly 18 per cent., of the deaths registeredin the eight towns last week were not certified.

HEALTH OF DUBLIN.

The rate of mortality in Dublin, which had been equal to31’2 and 3t’0 per 1000 in the two preceding weeks, declinedagain to 31 ’6 in the week ending the 12thinst. During the firstsix weeks of the current quarter the death-rate in this cityaveraged no less than 34 5 per 1000 ; whereas the mean ratein London and Edinburgh during the same period did notexceed 22 ’6 and 20’3 respectively. The 212 deaths in Dublinlast week showed a declme of 16 from the number in theprevious week, and included 12 from " fever," 4 from whoop-ing-cough, 3 from measles, 1 from diarrhoea, and not oneeither from small-pox, scarlet fever, or diphtheria. Thus20 deaths resulted from these principal zymotic diseases,against 18 and 14 in the two previous weeks; they wereequal to an annual rate of 3’0 per 1000, against 2-3 and 2’4from the same diseases in London and Edinburgh respec-tively. The deaths referred to "fever," which had steadilydeclined in the six preceding weeks from 13 to 4, rose againto 12 last week. The 4 fatal cases of whooping-cough corre-sponded with the number in the previous week; the 3 ofmeasles, however, exceeded the number in any previousweek of this year. The deaths of infants showed an increase,whereas those of elderly persons were less numerous thanthose in the previous week. The causes of 34, or more than16 per cent., of the deaths registered during the week werenot certified.

THE SERVICES.

Brigade-Surgeon R. W. Carter, Army Medical Depart-ment, having reported his arrival at Aldersbot, has assumedthe duties of sanitary officer of the Division, vice DeputySurgeon-General J. Elkin, C.B.ARMY MEDICAL DEPARTMENT.-Deputy Surgeon-General

Edward James Franklyn, M.D., to be Surgeon-General, viceJ. L. Holloway, C.B., deceased. Brigade Surgeon LeonardKidd, M.B., to be Deputy Surgeon-General, vice E. J.Franklyn, M.D. Surgeon-Major John Henderson Whittaker,to be Brigade Surgeon, vice L. Kidd, M.B.MADRAS MEDICAL ESTABLISHMENT. -To be Brigade

Surgeons: Surgeon-Major Geo. Bidie, Surgeon-Major JohnHenderson, M.D.ADMIRALTY.-In accordance with the provisions of Her

Majesty’s Order in Council of April 1st, 1881, Inspector-General of Hospitals and Fleets Sir John Watt Reid, K. C. B.,M.D., Director-General of the Medical Department of theNavy, has been placed on the Retired List from the10th inst. Fleet Surgeon Belgrave Ninnis, M.D., has beenpromoted to the rank of Deputy Inspector-General of Hos-pitals and Fleets in Her Majesty’s Fleet, with seniority ofMay 5th, 1883.

Correspondence.

THE SCOTCH CORPORATIONS AND THEMEDICAL BILL.

"Audi alteram partem."

To the Editor of THE LANCET.SIR,—Great is the present commotion in the camp of the

medical and surgical corporations of Glasgow and Etlin-

burgh. Their pretty bubble, long a tenacious soap filmgilded with rainbow colours, is at length on the eve of beingreduced to an obscure drop of liquid. How hard is the deathof their system of bringing discredit on Scotch diplomaswhich has made the English and Irish corporations sneer somuch ! Why is it that so many Irish and English studentsand licentiates cross the Channel and the Border to reside for afew days in Edinburgh and Glasgow? It cannot be to profitby the medical education of these cities, for their period ofresidence is too short for that purpose. Do they not comemerely for the purpose of obtaining a Scotch diploma? Is itbecause of the honour conferred by that diploma that somany Irish give their own corporations the " go.bye " andflock to the Colleges of Physicians and Surgeons of Edinburgh,and to the Glasgow Faculty of Physicians and Surgeons, or isit because the examinations held by the Colleges and Facultyin question have been so conducted that those who havelittle chance of passing examinations elsewhere take refugewith the kindly and considerate corporation examiners ofGlasgow and Edinburgh? How modest and becoming istheir boast that they yearly give more medical licences thanthe Scotch universities give medical degrees. They placethat to their own credit. Those who know what they reallyare count it their shame. Does the Glasgow Facultysuppose that if it hides its small head in the !’and that itsfeathers are not exposed to view ? Did the Royal Collegeof Physicians of Edinburgh suppose that no ill effect wouldeventually accrue to them when in their so-called " year ofgrace" they gave for a sum of money the diploma of physicianto 200 English practitioners, licentiates of the Apothecaries’Society, and members of the London College of Surgeons,without subjecting them to even the shadow of an exami-nation ? Does the same college now regret having continued

- to sell its Fellowship simply for so many pounds until evena few years ago ? Did they, when Medical Bills began tomenace them, discontinue that practice from a co-feeling of

- alarm at its effects, or of shame at its results ? Is the RoyalCollege of Surgeons of Edinburgh not even to day ashamed

i of continuing to sell its Fellowship without examination,even to men in England who wish to avoid the examinationfor the Fellowship of the College of Surgeons of London ?

. How wise, no doubt, they would have shown themselvescould they have seen themselves as others have seen them,and could they have measured the steadily growing indigna-